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OPTICAL NEURITIS AFTER BEE STING: A CASE REPORT

Authors:
  • Studio mind Asti
  • Studio medico "Mind", Asti, Italy

Abstract

A variety of unusual or unexpected reactions have been described occurring in a temporal relationship to insect stings, although there is scarce information regarding the pathogenesis of the majority of these unusual reactions Reisman, 2005).Acute encephalopathy occurred 8 days after yellow jacket stings, without any other obvious cause (Maltzman, Lee, and Miller, 2000). There have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and Guillain-Barré syndrome related to insect stings. Schiffman et al. (Schiffman et al., 2004) reported on a middle aged woman who sustained both a stroke and ischaemic optic neuropathy after multiple bee stings. As the result of ocular stings, local reactions have occurred with corneal pathology leading to cataracts (Choi and Cho, 2000)(Keller, 1995). Other prior reported reactions to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy (Berríos and Serrano, 1994) (Berríos and Serrano, 1994; Song and Wray, 1991).
ORIGINAL RESEARCH ARTICLE
OPTICAL NEURITIS AFTER BEE STING: A CASE REPORT
2,3Maurizio Cavallini,1,3,*Marco Ermete Boido,2,3,4Ilaria Lombardi, 2,3Claudia Aceto
and 3,5Tatsiana Volchik
1Department of General Psychology, University of Padova, Italy
2Department of General Psychology, University of Turin, Italy
3Department of Neuroscience, Studio Medico Associato Mind, Asti Italy
4Department of Clinical Psychology and Healt, Cardinal Massaia Hospital, Asti Italy
5Department of Chemestry,University of Minsk
ARTICLE INFO ABSTRACT
A variety of unusual or unexpected reactions have been described occurring in a temporal
relationship to insect stings, although there is scarce information regarding the pathogenesis of the
majority of these unusual reactions Reisman, 2005).Acute encephalopathy occurred 8 days after
yellow jacket stings, without any other obvious cause (Maltzman, Lee, and Miller, 2000). There
have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and
Guillain-Barré syndrome related to insect stings. Schiffman et al. (Schiffman et al., 2004) reported
on a middle aged woman who sustained both a stroke and ischaemic optic neuropathy after
multiple bee stings. As the result of ocular stings, local reactions have occurred with corneal
pathology leading to cataracts (Choi and Cho, 2000)(Keller, 1995). Other prior reported reactions
to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy
(Berríos and Serrano, 1994) (Berríos and Serrano, 1994; Song and Wray, 1991).
Copyright ©2017, Maurizio Cavallini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION
A variety of unusual or unexpected reactions have been
described occurring in a temporal relationship to insect stings,
although there is scarce information regarding the
pathogenesis of the majority of these unusual reactions
(Reisman, 2005). Acute encephalopathy occurred 8 days after
yellow jacket stings, without any other obvious cause
(Maltzman, Lee, and Miller, 2000). There have been prior
reports of other neurological reactions, myasthenia gravis,
peripheral neuritis and Guillain-Barré syndrome related to
insect stings. Schiffman et al. (Schiffman et al., 2004) reported
on a middle aged woman who sustained both a stroke and
ischaemic optic neuropathy after multiple bee stings.
*Corresponding author: Marco Ermete Boido
1Department of General Psychology, University of Padova, Italy
3Department of Neuroscience, Studio Medico Associato Mind, Asti
Italy
As the result of ocular stings, local reactions have occurred
with corneal pathology leading to cataracts (Choi and Cho,
2000) (Keller, 1995). Other prior reported reactions to ocular
stings include conjunctivitis, corneal infiltration, lens
subluxation, and optic neuropathy (Berríos and Serrano, 1994)
(Berríos and Serrano, 1994; Song and Wray, 1991).
Case report
A 66-year-old woman, whose past medical history was
significant only for controlled arterial hypertension and
diabetes mellitus, presented at emergency room after being
stung by an hornet on the left temporal region of the head. She
received an antiseptic medication and then she was discharge.
The day after, the patient experienced a severe headache with
nausea and vomiting and sudden blurred vision in the left eye.
An ocular examination revealed best corrected visual acuity
(BCVA) of 20/20-1 right eye and 20/30-2 left eye at distance
and 20/20 right eye and 20/200 left eye at near. Pupil
examination showed isocoria with no relative afferent
pupillary defect.
ISSN: 2230-9926
International Journal of Development Research
Vol. 07, Issue, 12, pp.17708-17709, December, 2017
Article History:
Received 17th September, 2017
Received in revised form
14th October, 2017
Accepted 09th November, 2017
Published online 29th December, 2017
Available online at http://www.journalijdr.com
Key Words:
Optical Neuritis,
Bee Sting.
Citation: Maurizio Cavallini, Marco Ermete Boido, Ilaria Lombardi, Claudia Aceto and Tatsiana Volchik. 2017.
“Optical neuritis after bee sting: a
case report.”, International Journal of Development Research, 7, (12), 17708-17709.
ORIGINAL RESEARCH ARTICLE OPEN ACCESS
Motility was unremarkable, as was anterior segment both eyes
and the funduscopic examination. Intraocular pressures were
18 mm Hg right eye and 16 mm Hg left eye. A Head
computed tomography was performed and resulted normal.
There was a delay in the P100 wave of the pattern visual
evoked potential (VEP) recording from the left eye, with a
normal response in the right eye. The patient received acute
treatment with high dose intravenous methylprednisolone (1 gr
day for 3 days) followed by 5 days with oral prednisone (1 mg
kg). Three days later, no recovery of the visual acuity in the
left eye was noticed: neuro-ophthalmic examination showed
BCVA of 20/15 right eye and 20/25 left eye at distance and
20/20 right eye and 20/30+1 at near; the pattern VEP was
abnormal. A further ocular examination 4 weeks after her sting
episode showed BCVA of 20/15 right eye and 20/25 left eye at
distance and 20/20 right eye and 20/30+1 at near. Three
months after, the patient reported no improvement of the visual
acuity in her left eye, and the data was confirmed by a repeated
visual examination.
DISCUSSION
The electrophysiological recordings initially showed a delay in
the P100 wave of the pattern visual evoked potential. The data
suggests that the optic nerve was demyelinated acutely, and
that subsequently axonal loss and degeneration of retinal
ganglion cells occurred. On follow-up, no visual acuity
recovery was reported.
Conclusion
It is important that clinicians be aware of this relationship
when assessing people with these reactions. Despite the few
previously report, in our patient an early corticosteroid
treatment was uneffective.
REFERENCES
Berríos, R. R. and Serrano, L. A. 1994. Bilateral optic neuritis
after a bee sting. American Journal of Ophthalmology,
117(5), 677–8. Retrieved from http:// ww.ncbi.nlm.nih.gov/
pubmed/8172283
Choi, M. Y. and Cho, S. H. 2000. Optic neuritis after bee sting.
Korean Journal of Ophthalmology, 14(1), 49.
https://doi.org/10.3341/kjo.2000.14.1.49
Keller, M. 1995. Neuritis nervi optici nach Wespenstich.
Klinische Monatsblätter Für Augenheilkunde, 206(5), 367–
368. https://doi.org/10.1055/s-2008-1035464
Maltzman, J. S., Lee, A. G. and Miller, N. R. 2000. Optic
neuropathy occurring after bee and wasp sting.
Ophthalmology, 10 7(1), 193–5. Retrieved from
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Reisman, R. E. 2005. Unusual reactions to insect stings.
Current Opinion in Allergy and Clinical Immunology, 5(4),
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pubmed/15985819
Schiffman, J. S., Tang, R. A., Ulysses, E., Dorotheo, N.,
Singh, S. S. and Bahrani, H. M. 2004. Bilateral ischaemic
optic neuropathy and stroke after multiple bee stings. The
British Journal of Ophthalmology, 88(12), 1596–8.
https://doi.org/10.1136/bjo.2004.042465
Song, H. S. and Wray, S. H. 1991. Bee sting optic neuritis. A
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17709 Maurizio Cavallini et al.
Optical neuritis after bee sting: A case report
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Article
Full-text available
Despite the common occurrence of insect stings and local and systemic allergic reactions,1 there are few reports of optic neuropathy or stroke following bee or wasp stings and, to our knowledge, there has been no report of both cerebral infarction and optic neuropathy occurring in the same patient after such an event. We report on a middle aged woman who sustained both a stroke and ischaemic optic neuropathy after multiple bee stings. A 57 year old white woman reported being stung by 30–40 bees, identified as Africanised honey (killer) bees, in the back of her neck, head, right eye, face, and right arm. She was treated with intravenous antihistamines and antiemetics at a local emergency room and released. Two days later, the patient experienced a severe headache with nausea and vomiting and noticed a left homonymous visual field loss. She went to see her primary doctor and while there became unresponsive, leading to …
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A variety of unusual or unexpected reactions have occurred in a temporal relationship to insect stings. This review will summarize these case history reports in recent years. As these reactions are very infrequent, the review will also include prior reported unusual reactions attributed to insect stings. Acute encephalopathy occurred 8 days after yellow jacket stings, without any other obvious cause. There have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and Guillain-Barré syndrome related to insect stings. Acute renal failure with tubular necrosis has occurred following massive numbers of stings from Africanized honeybees. Nephrotic syndrome has been reported in the past following single stings. Silent myocardial infarction has occurred, probably related to acute anaphylactic symptoms immediately following a sting. There are recent reports of other pathology, diffuse alveolar hemorrhage and rhabdomyolysis and prior reports of thrombocytopenic purpura and vasculitis. As the result of ocular stings, local reactions have occurred with corneal pathology leading to cataracts. Other prior reported reactions to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy. There is scarce information regarding the pathogenesis of the majority of the unusual reactions and the subsequent allergic status or risk for sting anaphylaxis of people who have had these unusual reactions. This review includes a variety of reactions, particularly involving neurological, renal and cardiovascular symptoms, related to insect stings. It is important that clinicians be aware of this relationship when assessing people with these reactions and address future prophylaxis.